Dermatology

Cancer research

Melanoma

Family medicine

Medicine

British Journal of Dermatology

decreased detection of the anaphylatoxin C5a (a marker of complement activation located downstream in the complement cascade) in CFT supernatants from the same experiments (Fig. 1b).Our in vitro results suggest that patients with BP may benefit from off-label LMWH use.Inhibiting ongoing complement fixation and C5a liberation by LMWH may improve skin disease, as suggested in part by BP disease models employing C5a receptor-deficient mice. 9Such therapy might also help prevent coagulation-related complications in BP, 2,10 but the risk vs. benefit in this regard would have to be carefully studied.LMWHs are generally considered safe therapeutics, although long-term side-effects do include osteoporosis, which is also a side-effect of standard BP therapy with corticosteroids.One limitation of our in vitro study may be the rather supraphysiological concentrations of TS used, but at the same time, a high-titre pool of BP sera was used for CFT, resulting in strong BMZ autoantibody binding.Given that clinically overt disease is seen at considerably lower titres of circulating autoantibodies in patients with BP and that the in vitro CFT also works with highly diluted BP sera by extending times of incubation with the fresh complement source (data not shown), we find it conceivable that lower, more physiological TS doses may also be effective, as already suggested in patients with complement-mediated renal disease. 7 In addition, there may be LMWHs other than TS that could inhibit complement better at similar or even lower doses.In summary, we suggest that patients with BP with complement deposits at the BMZ may benefit from LMWH administration.Positive effects of LMWH may also be observed in other complement-fixing diseases such as mucous membrane pemphigoid, epidermolysis bullosa acquisita, autoantibodymediated forms of glomerulonephritis and C3 glomerulonephritis.To confirm conclusively the therapeutic potential hypothesized in this report, additional in vivo studies employing animal models and randomized controlled trials in patients are warranted.

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